Millions on the brink of losing Medicaid coverage

The number of Americans on Medicaid is expected to top 100 million this month. But millions of those who enrolled in Medicaid coverage during the COVID-19 pandemic are on the brink of losing that coverage, after the omnibus spending bill enacted by Congress in December changed the enrollment rules.

States that received extra Medicaid funding under a 2020 COVID-19 relief bill had to agree to pause beneficiaries’ eligibility verifications. The continuous enrollment in Medicare was set to end when the public health emergency is over, which is likely to happen sometime in 2023. Known as The Great Unwinding, the undoing of many health coverage requirements and incentives put into place as a result of the COVID-19 public health emergency declaration and related legislation will be undone when the public health emergency is over.

Under the $1.65 trillion federal spending bill approved by Congress in December, states can begin disenrolling people from Medicaid in April even if the public health emergency designation remains in place. Many of those who will lose coverage are likely to qualify for coverage under the Affordable Care Act, according to public-health officials and advocates.

The legislation will sunset a requirement of the COVID-19 public health emergency that prohibited states from booting people off Medicaid. The Biden administration has been under mounting pressure to declare the public health emergency over, with 25 Republican governors asking the president to end it, citing growing concerns about bloated Medicaid enrollment.

As many as 18 million people could lose coverage, according to estimates from the Urban Institute.

States are gearing up for the effort and the Department of Health and Human Services is providing outreach and guidance to assist. The agency issued a proposal that would let state Affordable Care Act marketplaces launch a special sign-up window for people who lose Medicaid to help prevent gaps in coverage.